Tummy Time
In 1992, The American Academy of Pediatrics recommended that infants be placed on their backs to sleep, and since then, the incidence of SIDS (Sudden Infant Death Syndrome) has decreased nationally. However, since that time, babies have spent less time on their tummies. The improved infant seats, baby carriers, car seats, swings and interchangeable carriers have also contributed to less physical contact with infants and tendency for them to spend more time on their backs. With infants spending so much time on their backs, they are not integrating primitive reflexes, developing adequate muscle tone or achieving motor milestones, which are the foundations for the development of higher-level skills.
There has also been an increase in the potential for malformation of infants’ heads. When on their back, there can be a tendency to turn the head to one particular side, which can lead to flattening of the head in one area.
Research has indicated that babies who spend extra time on their tummies actually roll, sit, crawl and pull to stand earlier than babies who don’t (although they all do master those skills).
When infants are born, their arms and legs are flexed in toward the center of their body and flexor tone is more prominent. Since the body develops cephalocaudal (head to toe), and proximodistal (center of the body out), it is important for them to work against gravity to develop neck control and trunk stability. It has been found that lack of development of the extensor muscles and trunk stability has contributed to poor sitting tolerance and hand control necessary for desk posture and handwriting. It is through creeping on hands and knees that they develop trunk and arm stability, as well as the coordination of the two sides of the body. The coordination of the arms and legs used in creeping then contributes toward the integration of primitive reflexes and allows for crossing the midline and efficient processing. Many infants today seem to either avoid creeping or spend minimal time in that position in order to achieve the upright posture, which requires less effort against gravity.
It has been found that delays in the development of these skills has been a contributing factor with children who experience difficulty with writing, art projects, organization, and for the ability to organize their thoughts for writing. These children do not tend to qualify for special education, but experience frustration with working to their potential.
There are various postures for holding, feeding, carrying and playing with babies that will encourage the development of muscle tone, stability, coordination, and overall processing to help your child achieve their fullest potential.
Positioning
- For feeding, diapering, bathing, or carrying, change the position frequently to encourage the baby to turn head to both sides and look in different directions.
- For snuggling, hold the baby in various positions. Hold him on both your right and left side; on your lap to either side; on each shoulder; on your back with the baby on your stomach. Encourage the baby to look to both sides.
- When using sling carriers, alternate sides so baby will look up to both sides
- Alternate which end of the crib the baby’s head is placed so they will look out to both sides
Carrying
- Rather than carrying the baby to and from the car in the car seat carrier, carry him on your shoulder, encouraging him to look around.
- Carry the baby at your shoulder, changing shoulders to encourage looking around. Support should be provided to the back of the head until he has enough support for independence.
- Carry the baby on your hip, alternating hips to encourage looking around.
- Carry the baby in the airplane position, supporting the baby on their stomach and trunk as needed.
- Carry the baby facing out to encourage visual tracking; this can also be done in a front pack carrier.
Tummy Time Activities
- Tummy time should occur several times a day from the time they are born, gradually increasing the amount of time on the stomach. A newborn demonstrates good flexibility of the neck and can easily turn their head to the side. If tummy time isn’t initiated until they are older, they may lose some of this flexibility and it will be harder for them to turn and lift their head. Babies may initially cry when on their stomach as it takes effort to hold their head up, and therefore all the more reason to start early with tummy time and increase the time on their tummy.
- When on the floor for tummy time, make sure the surface is clean and free of any small item they could ingest. The blanket or surface should not be fuzzy and should be firm. The baby needs to be supervised at all times.
- Place the baby over a rolled towel, blanket or Boppy pillow, to encourage picking up the head
- Place baby over your lap, raising one leg slightly higher to provide an incline.
- On your back, lay baby on tummy facing you and engage with singing, facial expressions or toys.
- Lie on your stomach to play with your baby. Place toys on either side to encourage reaching and visual tracking.
- A parent’s face is often motivating for a child to look up toward, as well as an appropriate mirror for babies.
- Use of toys, music and moving objects will usually catch their attention. A mylar balloon can be entertaining as long as the child is not able to obtain it, and the activity is monitored.
Providing physical contact in various positions, tummy time and opportunities for your baby to develop head control and trunk stability will promote muscle tone and stability to assist with the development of higher-level skills. As the baby gains strength, encourage him to get up on elbows and then on extended arms. Place toys to the baby’s side to encourage reaching. It is important to not always have them contained when seated, but rather sitting on the floor and protected from a fall by nearby pillows. They need to work on trunk stability and balance as well as protective reflexes, which can only be done by practicing reaching and regaining an upright posture. Once up on hands and knees, they will first rock back and forth before moving. This position will further develop their muscle tone and strength before they begin to shift their weight and move the arms and legs for creeping. When on their back, encourage rolling by extending the arm closest to the surface up and over the head. As your baby experiences the various movement patterns, they will integrate reflexes and develop the foundations for higher-level movement patterns to occur.
If you have any questions concerning motor development, consult with your pediatrician.